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New Treatment Offers Relief from BPH

For many men, urinating can become a real pain – both figuratively and literally – as they get older, thanks to blockage caused by an enlarged prostate. This blockage, called benign prostatic hyperplasia (BPH), not only interferes with urination, but can also lead to bladder infections and kidney stones. The most effective treatment we’ve come up with so far is a surgical procedure called TURP (Transurethral Resection of the Prostate), which involves anesthesia, a hospital stay, and a catheter for a couple of days afterwards – not an ideal solution.

So, for many years, urologists have been looking for an outpatient treatment that can reduce prostate blockage with minimal risks and complications. We’ve tried medications, lasers, freezing, microwaves, heating and every combination of removing and destroying the prostate tissue that is causing the blockage, all with mixed reviews.

But there’s a new non-surgical treatment on the block that’s been getting good buzz from doctors and patients, alike — it seems to work well, and with fewer side effects than the more invasive treatments. The treatment is called “prostate urethral lift” (PUL), but it’s more commonly known by the name of the device used to perform the treatment, Urolift.

The only FDA-approved device of its kind, the Urolift uses small bolsters to tack the prostate up against its own surrounding layers (kind of like tying back window curtains), effectively lifting the blocking tissues up and out, opening up the channel to allow men to urinate with fewer problems. Several of these implants are inserted into the prostate on each side, up through the urethra. Placed in the urologist’s office, many men often describe immediate benefits. Of course, no treatment is right for everyone, so each patient is tested to assess the degree and location of blockage to see if the Urolift has a good chance of being effective for them.

I haven’t done the procedure – and I don’t expect I will, as I focus exclusively on vasectomy reversal now – but I watched several being placed, and after 35 years as a urologist performing many thousands of prostate surgeries, this procedure seems to be simple, safe, and effective. Some men who are in retention with a catheter can get these placed and go home urinating without a catheter! The procedures I watched took place in the urologist’s office, and the men were reading while the implants were being placed.

If you’re considering this procedure, a few things you may want to know:

Results can vary. Because everyone has their own unique pattern of growth and blockage, some men get great results while others may not. And because the tissues are still there and growing, some men may experience good results for a while but then will need other treatments such as medications or more definitive surgical treatments like a TURP.

Side effects. Side effects are minimal, but can include urinary discomfort, increased urge to urinate, pelvic discomfort, and blood in the urine. All of these, if experienced, resolve within the first couple of weeks. It’s important to point out that, unlike many of the other treatments for PBH, this procedure does not carry the risk of sexual side effects – a big bonus!

Removal. If for some reason there is a problem with the Urolift implants, they can be removed.

Cost. Most insurance plans pay for the testing and implants. Always ask your urologist first before you agree to have any testing or implants, just to be sure it is covered service as otherwise they are very expensive.

Time will tell us more. As with any new treatment, if you don’t really need it today, then it is always smart to wait and see if the long term benefits are as good as we anticipate they will be. As an older guy (now 61), I anticipate that someday I will need some treatment, and so far, this one looks the most promising and the least risky and invasive.

If you have severe obstruction, or you don’t get good results from the Urolift, then the TURP is still considered the gold standard with the best chances for long term success. If you have any questions, talk to your urologist. And, as with any surgery, always seek out the most experienced surgeon to get the very best results.

Sheldon Marks, MD, is director of the International Center for Vasectomy Reversal in Tucson, one of the leading specialty centers in the world. Dr. Marks is a best-selling author and frequently teaches other urologists about advances and techniques with vasectomy reversals. He has been writing for WebMD since 2005.

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